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50. A 17-year-old patient presents with severe pruritus that is worse at night. Upon examination of the skin, areas of excoriated papules are observed in the interdigital area. Family members report similar symptoms. Which of the following is the most likely diagnosis?

a. Scabies b. Cutaneous larva migrans c. Contact dermatitis d. Dermatitis herpetiformis e. Impetigo

51. A 35-year-old woman who had been camping in Wisconsin 2 wk ago develops an erythematous rash on her inner thigh. The macular lesion is 10 cm in diameter and had a distinct red border with central clearing. Two days ago, a second similar lesion developed. The patient reports no fever, chills, or other symptoms. She has no medical problems or allergies and takes no medications. She does not recall any spider or tick bites. The rest of the physical examination is normal. Which of the following is the most likely diagnosis?

a. Brown recluse spider bite b. Borrelia burgdorferi infection c. Bartonella henselae infection d. Mycobacterium marinum infection e. Ricketsia ricketsii infection

52. A 31-year-old man presents to the emergency room 3 days after undergoing a hernia repair operation. He is febrile and hypotensive. The symptoms began with the sudden onset of a diffuse, maculopap-ular rash that was pruritic and erythematous. On cutaneous examination, the erythroderma involves the palms and soles and is beginning to desquamate. The patient has no other illnesses and takes no medications. Which of the following is the most likely diagnosis?

a. Toxic epidermal necrolysis b. Toxic shock syndrome c. Necrotizing fasciitis d. Scarlet fever e. Cellulitis

53. A 6-year-old child presents complaining of patchy hair loss on the back of the scalp. Examination reveals well-demarcated areas of erythema and scaling, and although there are still some hairs in the area, they are extremely short and broken in appearance. Which of the following is the most likely diagnosis?

a. Androgenic hair loss b. Psoriasis of the scalp c. Seborrheic dermatitis d. Tinea capitis e. Carbuncle

54. A 37-year-old man who works in a fish market presents with a burning pain in his right hand for 1 wk. Physical examination reveals a large, violaceous plaque on his finger. Gram stain reveals no organism. Which of the following is the most likely diagnosis?

a. Erythrasma b. Ecthyma c. Erysipelas d. Erysipeloid e. Nummular eczema

55. Five days after going on a nature walk, a 13-year-old boy develops well-demarcated, erythema-tous plaques and vesicles over his arms and face. The plaques are arranged in a linear fashion and are crusting. The boy has some facial edema. He has no history of fever or chills but complains of pruritus. Which of the following is the most likely diagnosis?

a. Rubeola b. Atopic dematitis c. Acute contact dermatitis d. Impetigo e. Erythema infectiosum

56. A 6-year-old child presents with flesh-colored papules on the hand that are not pruritic. Examination reveals lesions that are approximately 4 mm in diameter with central umbilication. A halo is seen around those lesions undergoing regression. Which of the following is the most likely diagnosis?

a. Verruca vulgaris b. Molluscum contagiosum c. Keratoacanthoma d. Herpetic whitlow e. Hemangioma

57. A 42-year-old man presents with blisters and erosions of his hands for 6 mo. He has noticed excessive hair growth on his temple lateral to his eyebrows. On physical examination of the skin, vesicles, bullae, and milia are visible on the dorsa of the hands. The patient complains of generalized malaise but has no other symptoms. Which of the following is the most likely diagnosis?

a. Porphyria cutanea tarda b. Acute intermittent porphyria c. Variegate porphyria d. Pemphigus e. Tinea versicolor f. Pemphigoid

58. A 59-year-old man has fine, scaly plaques over his abdomen that have been recurrent for 15 years. Several skin biopsies have been nondiagnostic (lymphocytic epidermal infiltrate) and the lesions respond poorly to topical steroids. The rest of the physical examination is remarkable for a small axillary lymph node. Which of the following is the most likely diagnosis?

a. Lichen planus b. Pityriasis rosea c. Mycosis fungoides d. Kaposi's sarcoma e. Seborrheic keratosis

DIRECTIONS: Each set of matching items in this section consists of a list of lettered options followed by several numbered items. For each numbered item, select the appropriate lettered option(s). Each lettered option may be selected once, more than once, or not at all. Each item will state the number of options to select. Choose exactly this number. Items 59-61

For each patient with skin abnormalities, choose the most appropriate diagnosis.

a. Discoid lupus b. Melasma c. Acne vulgaris d. Red man syndrome e. Spider angioma f. Petechiae g. Rosacea h. Ecchymoses i. Purpura j. Telangiectasia

59. A 15-year-old presents with inflammatory papules, pustules, and crusting on the forehead and cheeks. (CHOOSE 1 DIAGNOSIS)

60. A 51-year-old woman presents with pustules and papules around the central parts of her face. She complains of facial flushing after drinking alcohol or hot fluids.


61. A 22-year-old woman in her fifth month of pregnancy presents with well-demarcated, hyperpig-mented macules on her cheek, nose, and forehead. (CHOOSE 1 DIAGNOSIS) Items 62-64

For each patient with ulcer formation, choose the most appropriate diagnosis.

Venous ulcer Arterial ulcer Neuropathic ulcer Aphthous ulcer Pressure ulcer

62. A 64-year-old patient with a history of previous strokes is chronically bedridden. Her nutritional intake is poor and she has fecal and urinary incontinence. She complains of pain in her lower back and has a low-grade fever.


63. A 67-year-old woman presents with a long history of aching and swelling of her legs relieved by elevation. Over the last several weeks, she has developed two blue-red, irregular, punched-out patches over the medial malleolus of her left leg. (CHOOSE 1 DIAGNOSIS)

64. A 55-year-old diabetic patient presents with complaints of a painful right leg when walking and at rest. The pain is worse at night and improves with dependency. His distal leg is porcelain white and cool to the touch. No dorsalis pedis pulse is palpable. A sharply demarcated, punched-out ulcer is visible over the supramalleolar area. (CHOOSE 1 DIAGNOSIS) Items 65-69

For each patient with abnormal nail findings, choose the most likely disorder associated with the nail finding.

a. Hepatic cirrhosis b. Iron-deficiency anemia c. Chronic renal failure d. Nephrotic syndrome e. Wilson's disease f. Severe stress g. Psoriasis h. Addison's disease i. Congestive heart failure j. Endocarditis k. Arsenic intoxication l. Antimalarial drugs

65. Koilonychia (CHOOSE 1 DISORDER)

66. Muehrcke's nails (CHOOSE 1 DISORDER)

67. Blue nails (CHOOSE 2 DISORDERS)

68. Beau's lines (CHOOSE 1 DISORDER)

69. Brown nails (CHOOSE 2 DISORDERS)

Items 70-71

For each patient with skin abnormalities, choose the most likely vitamin deficiency.

a. Zinc deficiency b. Niacin deficiency c. Vitamin C deficiency

70. A 71-year-old woman presents with ecchymoses and peri-follicular hemorrhage on her legs in a "saddle" distribution (how a rider would touch the saddle). She is edentulous with bleeding gums and is anemic. She lives alone and eats a diet of no added fruits or vegetables. (CHOOSE 1 VITAMIN DEFICIENCY)

71. A bottle-fed infant presents with the triad of acral dermatitis, alopecia, and diarrhea. (CHOOSE 1 VITAMIN DEFICIENCY)

Items 72-73

For each patient with skin abnormalities, choose the most appropriate lymphoma.

a. Adult T-cell leukemia/lymphoma b. Sezary syndrome (cutaneous T-cell lymphoma)

c. Cutaneous B-cell lymphoma

72. A 65-year-old man presents with intractable pruritus and diffuse erythroderma. He has generalized lymphadenopathy and leukocy-tosis. Examination of the buffy coat smear reveals abnormal circulating T cells. (CHOOSE 1 LYMPHOMA)

73. A 57-year-old woman presents with a large, red, nodular lesion on her abdomen. She had lymphade-nopathy and hepatosplenomeg-aly. Her leukocyte count is over 500,000/^1 and her serum calcium level is elevated. (CHOOSE 1 LYMPHOMA)

Items 74-76

For each patient with skin abnormalities, choose the most likely disorder.

a. Superficial spreading melanoma b. Basal cell carcinoma c. Squamous cell carcinoma d. Bowen's disease e. Actinic keratoses f. Seborrheic keratoses g. Leukoplakia h. Erythroplasia of Queyrat

74. A 50-year-old construction worker presents with a slow-growing eroded papule on his lower lip. He has a history of leuko-plakia and was a heavy smoker. He has a small, tender supraclavicular node. (CHOOSE 1 DISORDER)

75. A 46-year-old man presents with a large, well-demarcated, ery-thematous, glistening plaque on his glans penis. (CHOOSE 1 DISORDER)

76. A 42-year-old man presents with a single, shiny, red nodule on his nose that appears to glisten and shine. (CHOOSE 1 DISORDER)

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